Or possibly their service in the military — and the stress of combat — left them distrustful of the government and content to get by on their own health insurance. Maybe they just wanted to be left alone.

For Fairview resident Stephen Henderson, it was a little bit of "all of the above." A Marine Corps combat Veteran of the Vietnam War, Henderson, 69, did not use the local Charles George VA Medical Center and its many benefits for decades.

Henderson served in Vietnam from 1969-70, at one point badly wrenching his knee during a firefight. When he got home, he was told to go the VA in Asheville.

"I had some injuries and some health issues, and the military felt it should be looked into by the VA," Henderson said. "To me, though, it was in total disarray, and the treatment was subpar."

Henderson was sent to a VA in Winston-Salem, where he was not impressed with the facility or the care. So he stayed away.

Reaching out to the disaffected

It was an all-too-common story in those days, one that led a generation of Veterans to just skip the VA. But care and services have improved drastically over the years.

An upcoming "town hall" gathering for Veterans aims to help more aging Veterans take advantage of programs and benefits that are too often left untapped. Slated for April 27, the event is tilted "Aging Veteran: What Do You Need To Know Planning For The Future." Topics will include health care and the aging, survivors benefits programs, burials at state and national cemeteries, and a presentation on "Wills in North Carolina and what happens if you do not have one."

Buncombe County resident Allan Perkal, an Air Force medic in Vietnam and a retired VA counselor, will moderate the town hall. He knows Henderson and is glad to see his fellow Veteran finally engaged in the system.

Vietnam Veterans, Perkal said, are the lowest percentage cohort in terms of Veterans applying for disability.

"A high percentage of Veterans never seek any treatment or put in for any service-connected disability, and they're walking around with serious problems," Perkal said. "He's an example of one of us who served in Vietnam and went on with his life, and the VA wasn't really a part of his life. He kind of put that on a shelf, but later in life, things began to change and improve, and he began to embrace the system that had alienated us."

Perkal is also chair of the Buncombe County Veterans Council and on the board of directors of the Vietnam Veterans of America, North Carolina State Council. Those organizations are teaming up with the Charles George VA Medical Center for the event, which will take place at Asheville-Buncombe Technical Community College.

It is free and open to all Veterans — not just Vietnam era Vets — as well as family members, caregivers and others who work with aging Veterans. The information is just as vital for caregivers and loved ones, as some of them can also be entitled to some benefits after a Veteran dies, or find help is available in caring for an ailing Veteran.

A 'complete turnaround'

A self-described "workaholic" who spent a career in plant management, sales and then as a manager in the city of Asheville's sanitation department, Henderson always had good health insurance. So he felt no need for VA health care.

"Then about nine years ago, I was with some friends and they encouraged me to go, and I went back to the VA," Henderson said. "It was a complete turnaround at the VA. I was treated with ultimate respect."

The health care providers also pointed out some issues Henderson had that were service-related, meaning the treatment was covered. That included a heart condition related to Agent Orange exposure, PTSD and his knee condition, which ultimately will require a knee replacement.

He's gotten counseling for the post-traumatic stress disorder, which includes participation in a VA writing program, as well as treatment for the heart problem and high blood pressure.

"I stayed away from the VA for several years, but at this stage of my life, I think I need to know all I can, and so do potentially my caregivers and my (girlfriend)," Henderson said. "I think this forum should give a lot of information I don’t have and most Veterans do not have."

Henderson and Jenny Kline have been together nine years and have four children between them, so he knows more than just one person is affected by his health.

WNC's Veteran population is older

Armenthis Lester, spokeswoman for the Charles George VA, said the most common programs Veterans are not taking advantage of are health care, telemedicine and mental health. Charles George, in East Asheville, also operates three community-based outpatient clinics, in Franklin, Hickory and Rutherford County.

In all, Charles George serves 47,190 Veterans in 23 Western North Carolina counties, but overall some 96,000 Veterans live in WNC. Not all Veterans are eligible for VA health care, as there are enrollment requirements related to length of service, service connected conditions and income.

"There are some Veterans who are not eligible for VA health care because they make too much money," Lester said. "However, we feel there are Veterans who are eligible for VA service, but are not taking advantage of them."

Dr. Molly McGaughey, chief of geriatrics and extended care at Charles George, said 59% of Veterans using the facility in 2018 were 65 or older.

"In 2013 it was 50%," McGaughey said. "So we've had a 9% growth in just the geriatric Veterans population."

Since last October, Charles George has established four new programs in geriatrics to address that growth, which officials expect to continue with the aging of the Baby Boom generation, those born between 1946-64. The new programs include a geriatric primary care clinic and a palliative care program.

When the Vietnam Veterans Association and Buncombe County Veterans Council approached the VA about the town hall, the medical center jumped at the chance to participate.

"We're happy to be able to bring this information to people, because these are such essential services and they can make a huge difference about how somebody feels at the end stages of their life," McGaughey said.

She'll speak on "Healthcare and the Aging" at the town hall, mentioning a program called "Choosing Home" that can include home hospice care and nursing help that benefits Veterans and their caregivers. She'll also talk about the VA's respite program, which allows caregivers time away from their loved one who is ailing, a crucial service in preventing burnout, McGaughey said.

A changed culture

As far as why Veterans might not seek out service, Lester said the reasons run the gamut. But she also acknowledged that Vietnam Veterans in particular may have bad feelings about the VA and government in general.

"Some older Veterans — Vietnam Veterans — were so badly mistreated when they returned from Vietnam, that they have no desire to partner with any government agency," Lester said.

She also acknowledged, "Some Veterans have been turned off by news coverage of VA nationally and have lost trust."

Lester stressed that the local VA has scored extremely high in recent national rankings among VA's, including number two in quality and number one in customer service in the nation, and as the best place to work. Partly as a result, the the local VA draws Veterans from Tennessee, Georgia and other parts of North Carolina because of its reputation.

"There’s a culture gap that we're trying to bridge that the VA has changed," McGaughey said. "We want them to know the VA is here to help them and to be a partner in their care."

Lester said Veterans "give various reasons why they do not seek out services," including:

Some Veterans feel that because they did not serve during a war or were never injured, they do not deserve services.

Some Veterans are unaware of their eligibility.

Getting good mental and physical health care can add years to a Veteran's life, and improve the quality of life.

"I do not have any VA-specific data, but many other studies have demonstrated a positive correlation between longevity and well-being in those who have access to health care generally," Lester said.

Often, older Veterans find themselves isolated and without a good social network to rely on, Perkal said. While the town hall is open to all Veterans, the mountains have more Vietnam Veterans than other cohorts, in part because of the large number of personnel who served during the Vietnam era —about nine million personnel served during the war years, with about 3 million of those serving in country.

At its core, the town hall is about connecting with other Veterans, Perkal said, bringing back some of that in-service camaraderie. Other town halls have addressed Agent Orange exposure and PTSD, and this is another chance to get the word out about benefits.

"We’re trying to reach those folks about what's available and trying to connect with folks," Perkal said. "We want to get the community to come out, to rekindle that sense of brotherhood and sisterhood that exists among Veterans that used to exists and can exist again."

A 'final gift'

McGaughey knows the topics of aging and end of life decisions can be tough ones for Veterans. Or for anyone, for that matter.

"Our culture does not like talking about death and dying," McGaughey said. "I think it takes tremendous strength and courage to have those conversations ahead of time."

One topic she'll address is "the final gift" — providing your family specific details about your end of life care, advanced directives and burial so they're not adrift under stressful circumstances.

"Often we see this in hospice or in the ICU, where family members want to do everything possible (to keep a loved one alive), because they didn’t know what their father wanted," McGaughey said. "Many times, they're feeling guilty about not knowing. That’s why it’s a tremendous gift — the final gift — to say to your loved ones, 'This is what I want.’"

For his part, Henderson cannot recommend the local VA enough. When nightmares returned because of his PTSD, he was able to get treatment. A recent cataract surgery was 100% covered, and even included implants so he can read without glasses.

"I think the men and women that utilize it have considerable trust now," Henderson said. "But there are still so many people who do not utilize the VA because of the way they were treated in the early 70s, and they don’t realize how good it is now."

Forum for Aging Veterans

What: A free town hall gathering, "Aging Veteran: What Do You Need To Know Planning For The Future."

Organizers: Vietnam Veterans of America North Carolina State Council, Buncombe County Veterans Council, and Charles George VAMC

Who it's for: Veterans, family members, caregivers, and others who work with aging Veterans.

Goal: To educate the aging Veteran and their family members to what they need to know planning for the future. Making sure the Veteran gets the healthcare they need as they age, and become knowledgeable regarding what benefits their survivors are eligible for.